Easing Mealtimes for Seniors with Alzheimer's

Question: I am facing troubles getting my dad to eat. He suffers from Alzheimer’s disease. Can you suggest some ways to make the process easier?

Answer: Let me begin with the statement that the disease itself seems to cause many people to eat less than they did before. Strangely, Alzheimer’s and some other dementias can cause other people to (compulsively) eat more, but from my 10 years of experience in helping families deal with this disease, it seems to be a small minority that eat more rather than less.

Let’s start with you becoming a detective. Why do you think he eats less?

• Are his meals occurring around the same time every day? In other words, is eating part of a standard routine that is set up for him every day? It should be. People with Alzheimer’s absolutely need the security of a standard routine that they can count on, to reduce their anxiety and allow them to relax and enjoy their food. They may not understand much of what is going on around them, but once the routine is established, their body clock will probably indicate to them that it is time to eat.

• Can he even see the food on the plate? Sometimes it really is difficult for people with Alzheimer’s to see some kinds of food on the plate, for example seeing mashed potatoes on a white plate. The answer may be change the color of the plate the food is on. Research has shown using red plates for their meals consistently allow people to see their food, and they eat more than before.

• Can he smell the food in front of him? Research has also shown that Alzheimer’s, for many people takes away their sense of smell, sometimes early in the disease. Our sense of smell actually helps us taste our food. Test his sense of smell by putting a number of things with different smells under his nose and watch his reaction. I mean things with good and bad smells, like onions or garlic, or apple pie. If there is no reaction, then you know he doesn’t smell the food, and his taste is diminished. So you would add more spices to his food to try to help him taste it. (Of course, no spices that would cause harm to his health like salt if he has high blood pressure.)

• Does he fumble with the utensils and get discouraged or frustrated just trying to get the food to his mouth? That would certainly lessen his desire to eat. Who wants to fail at something so basic? The answer is either special utensils (oversized grips) to make it easier for arthritic hands (or for people with Parkinson’s disease) to grip and hold on to the utensil long enough for him to get the food to his mouth. There are also special plates and bowls in existence that allow him to push the food around on his plate so that he can get it on the utensil more easily. You can find them on Amazon.com, just type in utensils or plates or cups for arthritis. Alternatively you can give him finger foods, like chicken fingers, fruit slices, etc. If he needs to eat with his fingers to get more food in him. What the heck? Why not? Who cares what it looks like? What’s the greater good here?

• Are you sitting right opposite him at the table and eating at the same time as he is? You should be. If he no longer remembers what a utensil is perhaps he can see you and mimic what you are doing. At a minimum, eating would be a shared, social activity for him, something to be enjoyed, not an activity that heightens his sense of being lonely. His attitude may brighten and he may eat more just because he’s enjoying himself!

• Are there too many items of food on the plate? Does it look overwhelming to him so he’s thinking, “I can’t possibly eat that much food” and doesn’t even try? Can he not make the choice between 3 items on the plate so he doesn’t even try? Test this concept out by only using small plates, and put one thing only on the plate, and then put it in front of him. It would be like a series of courses to you but may be the first time he sees something to eat on each plate to him (if his short term memory is that short).

• Finally, if he is late in the disease, (not walking, can’t speak more than a few words or put a complete sentence together), have his doctor write an order to have a speech therapist do a “swallowing study”. He may be beginning not to be able to swallow his food anymore. (His brain is no longer sending the necessary signals to the throat muscles to expand and contract to allow the food to pass through to his gastrointestinal system. If that is the case, I suggest that you consider calling in hospice, because his body is preparing to enter the end of life.

Carole Larkin MA, CMC, CAEd, QDCS, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. Her company, ThirdAge Services LLC, is located in Dallas, TX.